"Washington has always been a private-practice town that delivers good care," says Dr. Arnold Kwart, head of urology at Washington Hospital Center. "But there has never been a dominant hospital here, so you've had to pick and choose the best place for a specific medical problem."
Our research, as well as a survey of more than a thousand local physicians, supports the conclusion that there is no "best" hospital here.
With the exceptions of Children's National Medical Center and the National Institutes of Health, Washington has not been a destination for medical expertise. "We practice very good medicine in this city that can effectively diagnose and treat 98 percent of the cases we get," says DC internist Dr. Bryan Arling, "but there is no medical institution here like Johns Hopkins in Baltimore."
In a 2004 study of hospital quality in 25 US cities, the Washington area ended up in the middle at 12th. The Cleveland area came in first, and the Portland/Salem area in Oregon was last.
According to hospital CEOs, Washington's medical scene is very competitive, with acute-care hospitals under financial pressure because of declining reimbursements from Medicare and managed-care companies.
"Every hospital in our area is in a survival mode," says Dr. Richard Becker, CEO of George Washington University Hospital.
One reason for the competition for health dollars is a decline in total patient days and the average length of stay in hospitals--despite the fact that patients now have to be sicker to be admitted to a hospital than they did ten years ago.
The competition for patients--especially those needing big-ticket procedures--has become so fierce that MedStar Health repeatedly sued the Maryland Health Care Commission to prevent the scheduled opening of an open-heart-surgery center at Suburban Hospital. MedStar's Washington Hospital Center also has a cardiac-surgery program. Hospitals that perform cardiac surgery make an average of $16,000 per procedure.
In such a tough environment, some hospitals have gone out of business. Columbia Hospital for Women and DC General Hospital have closed. DC General's closing has put added pressures on Children's, Washington Hospital Center, Greater Southeast, Providence, and Howard University hospitals, which have to absorb the indigent patients who would have used DC General. Howard has proposed building a new hospital on the site of the old DC General.
The financial pressures at Georgetown and George Washington university hospitals became so great that both were sold. Declining reimbursement hit academic hospitals hard--particularly those without big endowments like Harvard or Johns Hopkins--because their shrinking income could not keep pace with the high cost of teaching and training.
"University hospitals were used to living high on the hog," one academic doctor laments, "and they have had a much harder time trying to retrench as the money grew tighter. I consider one of the tragedies here in Washington to be the difficulties our local university hospitals have had and continue to have. It's created a kind of vacuum, and I hope these hospitals will be able to pull themselves out of it."
Not that many years ago, medical people considered GW and Georgetown the area's strongest hospitals, the places to go for serious medical problems. Only Washington Hospital Center rivaled them, and a standing joke was that most nonacademic and suburban hospitals were good places to go if you weren't really sick. This joke is no longer told. Suburban hospitals have moved into the vacuum and are eclipsing GW and Georgetown.